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Y2 - ENDO > Menopause, HRT and Oral Contraceptives > Flashcards

Menopause, HRT and Oral Contraceptives Flashcards

1
Q

Define menopause?

A

Permanent cessation of menstruation

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2
Q

Why does menopause occur?

A

Due to loss of follicular activity

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3
Q

What is the average age range for onset of menopause?

A

45-55

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4
Q

What does it mean to describe menopause as climacteric?

A

The patient may go through a transition period

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5
Q

Give 7 symptoms of menopause

A
  1. Hot flushes (head, neck, upper chest)
  2. Urogenital atrophy leading to…
  3. …Dyspareunia
  4. Sleep disturbances
  5. Depression
  6. Decreased libido
  7. Joint pain
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6
Q

Outline the normal HPG axis and the changes that occur in relation to it during menopause

A
  • The hypothalamus secretes GnRH
  • This stimulates pituitary to secrete LH / FSH
  • This stimulates oestrogen and inhibin B from the ovaries
  • Oestrogen and inhibin B have negative feeback effects at the pituitary (inhibiting LH / FSH release) and the hypothalamus (inhibiting GnRH)

During menopause:

  • The production of oestrogen and inhibin B lowers and thus there is also less negative inhibition on secretion of LH / FSH and GnRH by the pituitary and the hypothalamus respectively
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7
Q

Give 2 possible complications of menopause and explain why this occurs

A
  1. Osteoporosis
    * Oestrogen is an anabolic hormone which preserves bone structure and so loss of oestrogen could lead to loss of bone matrix and thus osteoporosis - increasing the risk of bone fracture
  2. CVD
  • Oestrogen improves the lipid profile and preserves endothelial function
  • Therefore loss of oestrogen leads increased risk of CVD
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8
Q

What symptom can HRT help treat in menopause?

A

Controls vasomotor symptoms - hot flushes

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9
Q

What 2 hormones are given in HRT, and why are they both given? Also, in what case would you only need to give one of these

A
  1. Oestrogen
  2. Progesterone
  • Unopposed oestrogen risks the development of endometrial hyperplasia and thus endometrial carcinoma
  • Progesterone helps prevent this risk
  • IF the patient has had a hysterectomy, they can just have oestrogen becuase there is no risk of endometrial hyperplasia / carcinoma
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10
Q

How can HRT be administered?

A
  • Cyclical - cycling between oestrogen and progesterone - oestrogen every day and progesterone the last 12-14 days
  • Continuous combined - both oestrogen and progesterone given, all the time
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11
Q

Give the 4 HRT formulations

A
  1. Oral Estradiol (1mg)
  2. Oral conjugated equine oestrogen (0.625 mg)
  3. Transdermal oestradiol patch for (50 micrograms
  4. Intravaginal -relevant for dyspareunia
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12
Q

How well is oestrogen absorbed and what is its bioavailability like?

A
  • Well absorbed
  • Low bioavailability due to high first pass metabolism
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13
Q

What are the 2 types of oestrogen provided in HRT (not referring to formulations here), and for one of them describe how it is adapted to have high bioavailability

A
  1. Estrone sulphate (oestrogen conjugate)
  2. Ethinyl oestradiol (semi-synthetic oestrogen) - the ethinyl group protects it from first pass metabolism
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14
Q

Give 5 side effects of HRT

A
  1. Breast cancer
  2. Coronary heart diseaese
  3. Deep vein thrombosis
  4. Stroke
  5. Gallstone
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15
Q

Oestrogen alone has beneficial effects on ….. ….. and ….. ….. but synthetic ….. negate these effects of oestrogen

A

Oestrogen alone has beneficial effects on lipid profile and endothelial function, but synthetic progestins negate these effects of oestrogen

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16
Q

What risks are there in older people (>60) taking HRT?

A
  • Increased atherosclerosis
  • Pro-thrombotic and pro-inflammatory effects of oestrogen
17
Q

In what age group would you get people getting the beneficial effects of oestrogen and when would you more likely get adverse effects?

A
  • Under 60s you’d get beneficial effects and in over 60s you’d get adverse effects
18
Q

What is Tibolone, what does it treat, and what risks are it associated with?

A
  • Synthetic prohormone with oestrogenic, progestogenic and weak androgenic actions
  • Reduces fracture risk
  • Increased risk of stroke (RR: 2.2) and possible increased risk of breast cancer
19
Q

1) How does Raloxifene work (what’s SERM) and what does it treat?
2) What increased risks is it associated with?

A

1)

  • Selective oestrogen receptor modulator
  • Oestrogenic in bone - reduces the risk of vertebral fractures
  • Anti-oestrogenic in breast and uterus: reduces breast cancer risk

2)

  • Increased risk of VTE
  • Increased risk of fatal stroke
20
Q

1) What is premature oestrogen insufficiency?
2) Causes of premature oestrogen insufficiency?

A

1)

  • Menopause before the age of 40

2)

  • Autoimmune
  • Iatrogenic - surgery, radiation, therapy
21
Q

2 drug names for progesterone given as part of HRT

A
  1. Levonorgestrel
  2. Norethisterone
22
Q

How does HRT in the COCP work to reduce fertility and what 2 substances does it contain?

A
  • Ethinyl oestradiol - causes negative feedback at the hypothalamus/pituitary to reduce fertility
  • Levonorgestrel - progestogens thicken cervical mucus - makes implantation harder
23
Q

1) In what cases would you give progesterone only contraceptives?
2) How are long acting progesterone only therapies administered (what route)?
3) Weaknesses of progesterone only contraceptives?

A

1)

  • When oestrogen use is contra-indicated

2)

  • Intra-uterine

3)

  • Short half-life
  • Short duration of action
24
Q

2 forms of post-coital contraception and how they work?

A

1.Copper IUD (intrauterine contraceptive device)

  • Affects sperm viability and function
  • Contain levonorgestrel (progesterone)
  1. Ulipristal (can be taken up to 12 hours after intercourse)
  • Anti-progestin (progesterone) activity
  • Delays ovulation and impairs implantation
25
Q

What does Tamoxifen do?

A
  • Anti-oestrogenic in breast tissue - treats breast cancer

Y2 - ENDO (18 decks)

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